AB0196 IMPACT OF ANTIRHEUMATIC TREATMENTS ON THE INDIVIDUAL COMPONENTS OF THE ACR COMPOSITE SCORE IN PATIENTS WITH RA: REAL-WORLD DATA FROM TWO REGISTRIES
Authors: L. Bessette, M. Movahedi, D. Choquette, L. Coupal, C. Bombardier, E. Keystone
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Standard criteria for measuring treatment efficacy in patients with RA include ACR response rates, which require meeting a threshold of ≥ 20/50/70% improvement in several physician- and patient-reported measures, including tender and swollen joint counts (TJC and SJC, respectively; primary criteria) and at least 3 of 5 secondary criteria (Physician (Ph) global assessment (GA), Patient (Pt) GA, Pain, HAQ-DI, and CRP). <h3>Objectives</h3> The purpose of the analysis was to evaluate the impact of csDMARDs, TNF inhibitors (TNFi), and tofacitinib (TOFA) on each ACR score component in real-life practice. <h3>Methods</h3> Clinical data of RA patients with a CDAI &gt;10 at the time they started a csDMARDs (all biologic naïve), TNFi or TOFA were pooled from two registries: Ontario Best Practices Research Initiative (OBRI) and RHUMADATA. Endpoints summarized descriptively included proportions of pts achieving: ACR20/50/70 responses, ≥ 20/50/70% improvements and mean percent improvement in individual ACR components (TJC, SJC, PhGA, PtGA, Pain, HAQ-DI, and CRP) at Month (M6). <h3>Results</h3> A total of 669 pts were included (csDMARD, n=157, TNFi, n=252; TOFA, n=260). At baseline, patients starting TOFA had longer disease duration, failed more bDMARDs and used more corticosteroids than csDMARDs and TNFi. The CDAI was similar between the 3 groups. ACR50 response rates were numerically lower for the TOFA group (Table 1). The ACR70 response was similar in the 3 groups. An overall higher proportion of patients in all three-medication groups achieved ≥20/50/70% improvement in primary ACR components vs secondary components. Among secondary components, ≥20/50/70% improvement rates were numerically highest for PhGA and lowest for HAQ-DI and pain. The improvement in the SJC and TJC were numerically similar between all groups (Table 1). Among ACR20/50/70 responders for all medications, mean percent improvement was more than 80% for primary components, and ranged from 30% to 80% for secondary components (Figure 1). <h3>Conclusion</h3> In this real-world practice analysis, physician-reported measures (TJC, SJC, and PhGA) contribute slightly more to overall ACR20/50/70 responses, compared with Pt-reported outcomes (PROs; PtGA, Pain and HAQ-DI). In the ACR20 response group, a lower-level outcome, the improvement of the SJC and TJC, exceeded 80%. Pain was the most important factor in achieving an ACR50 for pts treated with TOFA, possibly reflecting the different effects of JAKi on pain. <h3>Acknowledgements</h3> We acknowledge the OBRI and RHUMADATA investigators. <h3>Disclosure of Interests</h3> Louis Bessette Grant/research support from: has served as a consultant or member of a speakers bureau for, and has received grant/research support from, AbbVie, Amgen, Bristol-Meyers Squibb, Celgene, Eli Lilly, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi-Aventis, Teva, and UCB., Mohammad Movahedi: None declared, Denis Choquette Grant/research support from: Rhumadata is supported by unrestricted grants from Abbvie Canada, Amgen Canada, Eli Lilly Canada, Novartis Canada, Pfizer Canada, Sandoz Canada and Sanofi Canada., Louis Coupal: None declared, Claire Bombardier Grant/research support from: OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC), Canadian Arthritis Network (CAN) and unrestricted grants from: Abbvie, Amgen, Aurora, Bristol-Meyers Squibb, Celgene, Hospira, Janssen, Lilly, Medexus, Merck, Novartis, Pfizer, Roche, Sanofi, &amp; UCB., Edward Keystone Grant/research support from: Amgen, Merck, Pfizer Pharmaceuticals, PuraPharm. Speaker Honoraria Agreements: AbbVie, Amgen, Bristol-Myers Squibb Company, Celltrion, Myriad Autoimmune, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, Sanofi-Genzyme, Samsung Bioepsis. Consulting Agreements/Advisory Board Membership: AbbVie, Amgen, Bristol-Myers Squibb Company, Celltrion, Myriad Autoimmune, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, Sanofi-Genzyme, Samsung Bioepsis.